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Flashcards in Settlement and legal management Deck (6)
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1

When a claim denial is appealed, what are the four levels of litigation (APPEAL) that can occur?

-In-person Admin Hearing with Administrative law Judge (ALJ) at the WCB Hearings Division

-Board review of the ALJ's opinion by the WCB

-Review by Oregon Court of Appeals

-Review by the Oregon Supreme Court

2

What are two common settlement types in a DENIED claim?

-Disputed Claim Settlement (DCS)" settles ALL BENEFITS in the claim

-Stipulation and Order (Stip) : an agreement to RESCIND THE DENIAL and ACCEPT the claim

3

What are the settlement options in an ACCEPTED claim?

-Claims Disposition Agreement (CDA)

-Disputed Claim Settlement (DCS) (if there is a PARTIAL denial in the claim

-Stipulation and Order (Stip)

4

What is the only benefit a worker cannot settle when agreeing to a CDA?

Medical benefits

5

How many days do insurers have to pay a CDA once it has been approved?

14 days from receipt of the approved order from WCB

6

What are the following statements:

-Settlements should reduce uncertainty for the IW, employer, and SAIF

-Parties affected by settlements MUST BE FULLY informed

-The settlement value of a claim is the present value of probable claim benefits discounted by the uncertainty of entitlement

-Claims employees have an affirmative responsibility for anticipating and preparing for litigation and for considering settlement only after adequate preparation.

-Disputed claim settlements should be employed where issues lack clarity as to compensability, or benefit entitlement.

Settlement Tenets